ABSTRACT
BACKGROUND: In approximately 10% of patients with implanted pacemakers or defibrillators, previously unrecognized atrial fibrillation (AF) is detected within 3â¯months. It is unknown whether elderly patients without implanted devices have a similar prevalence of undiagnosed AF using non-invasive ECG monitoring, and if this approach to screening in this population is cost-effective. METHODS: Individuals ≥80â¯years old attending outpatient clinics without a history of AF and with hypertension and one additional risk factor underwent 30â¯days of continuous ECG monitoring with an option for an additional 30â¯days of monitoring if no AF was detected. The primary outcome was AFâ¯≥â¯6â¯min. Cost-effectiveness to prevent stroke was estimated using a Markov model based on observed AF detection rates and data from the published literature. RESULTS: Among 129 patients enrolled, 100 initiated monitoring for an average duration of 36⯱â¯21â¯days. The proportion of patients that completed at least 30â¯days of monitoring was 59%. Average age was 84⯱â¯3â¯years and mean CHA2DS2-VASc score was 4.5⯱â¯1.2. AFâ¯≥â¯6â¯min was documented in 14%, ≥6â¯h in 8%, and ≥24â¯h in 3%. One week of monitoring costed $50,000 per quality-adjusted life-year-gained, 30â¯days and 60â¯days of monitoring costed $70,000 and $84,000, respectively. CONCLUSIONS: Continuous non-invasive ECG monitoring is feasible in elderly patients. Undiagnosed AF is present in many elderly individuals, with 1 in 7 having episodes lasting ≥6â¯min. One week of monitoring may be cost-effective for stroke prevention in this population.